Hepatocellular Carcinoma Management in Renal Dysfunction
Summary
Hepatocellular carcinoma (HCC) frequently coexists with varying degrees of renal impairment, ranging from mild dysfunction to dialysis-dependent end-stage renal disease. Renal dysfunction alters tumour biology, patient tolerance to interventions and pharmacokinetics of systemic therapies. The interplay between liver and kidney function influences prognosis and dictates careful adaptation of curative and palliative strategies. Curative options such as surgical resection, orthotopic liver transplantation and percutaneous ablation must be balanced against the higher risk of perioperative and postoperative complications in patients with reduced glomerular filtration rate. Meanwhile, locoregional approaches including transarterial chemoembolisation require monitoring for procedure-related acute kidney injury and adjustments in contrast use. Systemic treatments, exemplified by targeted therapies and immunotherapies, present unique challenges in the context of altered drug clearance and nephrotoxicity. Risk stratification tools incorporating markers of renal and hepatic reserve have emerged to guide individualised decision-making. Recent advances in antiviral regimens and immunomodulation have further refined management pathways, underscoring the need for multidisciplinary collaboration to optimise outcomes in this complex patient population.
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Hepatocellular Carcinoma Management in Renal Dysfunction publication trend
The graph below shows the total number of articles in hepatocellular carcinoma management in renal dysfunction across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic kidney disease (CKD): Gradual loss of kidney function classified by reduced glomerular filtration rate and markers of damage.
End-stage renal disease (ESRD): The final stage of CKD requiring renal replacement therapy such as haemodialysis or transplantation.
Acute kidney injury (AKI): A rapid decline in renal function often triggered by medical interventions or contrast exposure.
Albumin-bilirubin (ALBI) grade: A model combining serum albumin and bilirubin levels to assess hepatic reserve.
Radiofrequency ablation (RFA): A minimally invasive technique using thermal energy to destroy tumour tissue.
Transarterial chemoembolisation (TACE): A locoregional therapy delivering chemotherapy and embolic agents directly to hepatic tumours.
References
- An Update on Hepatocellular Carcinoma in Chronic Kidney Disease. Cancers (2021).
- Survival of Patients with Hepatocellular Carcinoma in Renal Insufficiency: Prognostic Role of Albumin-Bilirubin Grade. Cancers (2020).
- Should we change the treatment plan in early hepatocellular carcinoma with chronic kidney disease?. BMC Surgery (2023).
- Does Chronic Kidney Disease Really Affect the Complications and Prognosis After Liver Resection for Hepatocellular Carcinoma? A Meta-Analysis. Frontiers in Surgery (2022).
- Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization. PLOS ONE (2020).
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